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Case Reports
. 2019 Mar 7;12(3):e228404.
doi: 10.1136/bcr-2018-228404.

Serotonin syndrome unmasking thyrotoxicosis

Geoffrey Peter Ronan  1 , Nicola Ronan  2 , Siobhan McGettigan  2 , Gemma Browne  1
Affiliations
Case Reports

Serotonin syndrome unmasking thyrotoxicosis

Geoffrey Peter Ronan et al. BMJ Case Rep. .

Abstract

A 26-year-old cachectic man presented with an altered mental status. He was agitated, tremulous, hyperthermic and diaphoretic with largely dilated pupils. Collateral history revealed acute ingestion of 3,4-methylenedioxymethamphetamine on a background of chronic drug abuse. His condition deteriorated requiring sedation and intubation with transfer to the intensive care unit. A diagnosis of serotonin syndrome was made, based on his findings in keeping with the Hunter criteria, and he was treated with supportive management during a resultant and briefly sustained delirium. With gradual resolution of his agitated state, further questioning and blood work a concurrent, and potentially contributory, thyrotoxicosis was revealed. The patient was commenced on treatment for this with urgent outpatient follow-up with both a local otolaryngologist and endocrinologist for consideration of further treatment.

Keywords: delirium; endocrine system; metabolic disorders; thyroid disease; toxicology.

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Conflict of interest statement

Competing interests: None declared.

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